Superior Labral Lesions Research Articles

MRI Findings of Periarticular Lesions with Isolated Greater Tubercle Fractures and Dislocation.

To identify MRI findings for injuries to periarticular soft tissue structures that were related to isolated greater tubercle fracture. 16 patients (mean age: 53.8, range 30-71 yrs) were enrolled and diagnosed with isolated greater tubercle (GT) fracture with CT and MRI and underwent shoulder arthroscopy from September 2009 to April 2019. Two musculoskeletal radiologists were blinded to the patient history and arthroscopic surgical findings and reviewed patient's CT and MRI. Fracture displacement, fracture center, and presence of bony Bankart lesion with Hill sachs lesion were checked on shoulder CT. Soft tissue injuries, including rotator cuff injury, deltoid muscle injury, long head of biceps tendon injury, capsular injury, glenoid injury, and injury location of the subscapularis and infraspinatus were checked on shoulder MRI. MRI showed supraspinatus injury (56.3%), subscapularis injury (56.3%), deltoid muscle injury (25%), infraspinatus injury (25%), teres minor muscle injury (37.5%), injury of the long head of the biceps tendon (43.8%), inferior glenohumeral ligament tear (87.5%), superior labral anterior-toposterior lesion (25%), Bankart lesion (18.8%), and Hill-Sachs lesion (6.3%). 88.9% of subscapularis injuries and 75% of infraspinatus injuries showed caudal predominance. All of the patients with infraspinatus injuries showed concomitant teres minor muscle injuries. In order of frequency, the fracture centers were anterior (25%), posterior (31.3%), and all (43.8%). For patients with Bankart and Hill- Sachs lesions, the fracture center included the posterior portion in all cases. MRI and active arthroscopic examinations may be valuable when an isolated GT avulsion fracture is identified on X-ray examination.

Posterior shoulder labrocapsular structures in all aspects; 3D volumetric MR arthrography study.

Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies have been associated with traumatic posterior dislocation. A smaller portion of the lesions include posterior extension of superior labral anteroposterior lesions, posterior superior internal impingement, and damage to the posterior band of the inferior glenohumeral ligament. Labrocapsular anatomic variations of the posterior shoulder joint can mimic labral pathology on conventional MR and occasionally on MR arthrographic images. Knowledge of this variant anatomy is key to interpreting MR images and studying MR arthrography of the posterior labrocapsular structure to avoid misdiagnosis and unnecessary surgical procedures. In this article, we review normal and variant anatomy of the posterior labrocapsular structure of the shoulder joint based on MR arthrography and discuss how to discriminate normal anatomic variants from labrocapsular damage.

What happens to the long head of the biceps tendon after arthroscopic rotator cuff repair?

The purpose of this study was to identify the changes in untreated long head of the biceps brachii tendon (LHBT) after a rotator cuff tear and to evaluate the factors related to the changes. A cohort of 162 patients who underwent isolated supraspinatus with the preservation of LHBT was enrolled and evaluated. The cross-sectional area (CSA) of the LHBT on MRI was measured in the bicipital groove, and preoperative to postoperative difference was calculated at least 12 months postoperatively. Second, postoperative changes in the LHBT including intratendinous signal change, rupture, dislocation, or superior labral lesions were evaluated with seeking of factors that were correlated with the changes or newly developed lesions after rotator cuff repair. The postoperative CSA (12.5 mm2 (SD 8.3) was significantly larger than preoperative CSA (11.5 mm2 (SD 7.5); p = 0.005). In total, 32 patients (19.8%) showed morphological changes in the untreated LHBT 24 months after rotator cuff repair. Univariate regression analysis revealed that the factor chiefly related to the change in LHBT status was an eccentric LHBT position within the groove found on preoperative MRI (p = 0.011). Multivariate analysis using logistic regression also revealed that an eccentric LHBT position was a factor related to postoperative change in untreated LHBTs (p = 0.011). The CSA of the LHBT inside the biceps groove increased after rotator cuff repair. The preoperative presence of an eccentrically positioned LHBT was associated with further changes of the tendon itself after rotator cuff repair. Cite this article: Bone Joint J 2020;102-B(9):1194-1199.

Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder.

Background:Superior labrum tears extending from anterior to posterior (SLAP lesion) are a cause of significant shoulder pain and disability. Management for these lesions is not standardized. There are no clear guidelines for surgical versus non-surgical treatment, and if surgery is pursued there are controversies regarding SLAP repair versus biceps tenotomy/tenodesis.Objective:This paper aims to briefly review the anatomy, classification, mechanisms of injury, and diagnosis of SLAP lesions. Additionally, we will describe our treatment protocol for Type II SLAP lesions based on three groups of patients: throwing athletes, non-throwing athletes, and all other Type II SLAP lesions.Conclusion:The management of SLAP lesions can be divided into 4 broad categories: (1) nonoperative management that includes scapular exercise, restoration of balanced musculature, and that would be expected to provide symptom relief in 2/3 of all patients; (2) patients with a clear traumatic episode and symptoms of instability that should undergo SLAP repair without (age < 40) or with (age > 40) biceps tenotomy or tenodesis; (3) patients with etiology of overuse without instability symptoms should be managed by biceps tenotomy or tenodesis; and (4) throwing athletes that should be in their own category and preferentially managed with rigorous physical therapy centered on hip, core, and scapular exercise in addition to restoration of shoulder motion and rotator cuff balance. Peel-back SLAP repair, Posterior Inferior Glenohumeral Ligament (PIGHL) release, and treatment of the partial infraspinatus tear with debridement, PRP, or (rarely) repair should be reserved for those who fail this rehabilitation program.

Comparative Study on Clinical Results of Arthroscopic Repair of Anteroinferior, Superior, and Combined Glenoid Labral Tear: A Two-Year Follow-Up Study

This study is first of its kind that compared clinical results of arthroscopic repair of anteroinferior, superior, or combined anteroinferior and superior labral lesion. The most significant finding is that 2-year outcomes of the three lesions are comparable, in terms of pain, shoulder functional scores, ROM, and failure rate. However, patients with superior labral lesion were older at surgery. Anteroinferior and superior glenoid labra are common anatomical locations susceptible to traumatic injuries which lead to shoulder instability. Both can be repaired arthroscopically, however, differences in surgical outcomes were largely unknown, especially on the association and difference between type II superior labral tear from anterior to posterior (SLAP) lesion and combined anteroinferior and superior labral lesion. The objective of this study is to compare and correlate the clinical results of arthroscopic repair of combined labral lesion with those of anteroinferior labral lesion and type II SLAP lesion. A comparative study, involving patients who underwent primary arthroscopic labral repairs by two fellowship-trained Sports surgeons was conducted. Patients below 40 year-old, who were admitted between 2010 and 2014 and have been followed up for at least 2 years, were included in the study. Patients with associated rotator cuff injury, posterior labrum injury, significant bony defect or humeral avulsion of glenohumeral ligament injury were excluded. They were divided into 3 groups based on arthroscopic findings: Group A consisted of 61 patients with anteroinferior labral lesion, Group B consisted of 16 patients with type II SLAP lesion, and Group C consisted of 19 patients with combined labral lesion. The outcomes measured in the study were pain score, shoulder functional scores (Constant Shoulder Score, UCLA Shoulder Score, and Oxford Instability Score), range of motion (ROM, in both forward flexion and abduction directions), and failure rate (re-dislocation or subluxation) at 2-year follow-up. Kruskal Wallis Test and Fisher’s Exact Test were applied for continuous and categorical variables, respectively. Except that patients from Group B were older (28.8 vs. 22.2 for Group A and 22.0 for Group C) at the time of surgery, no significant differences exist among the three groups in patients’ demographics and relevant clinical data. Pain scores were comparable, with a slightly higher reported value for Group B at 2-year. There were no differences among the three groups in shoulder functional scores. Slightly higher improvements in functional scores were observed in Group B compared to the other two groups, without statistical significance. Both forward flexion and abduction ROMs have improved significantly from pre-operative values, for all three groups; however, they were not significantly different among each other at the 2-year follow-up. Improvements in ROM were highest in Group C, but these did not achieve statistical significance. Failure rate was also similar in all groups, regardless of the types of lesion. This study is first of its kind, which tries to establish the relationship of combined labral lesion with either anteroinferior or superior labral lesion, in terms of clinical results of arthroscopic repair. Patients with type II SLAP lesion underwent surgery at an older age. Combined labral lesion is a potential concomitant lesion in anteroinferior labral lesion or SLAP lesion, and comparable results can be expected in terms of pain, shoulder functional scores, ROM, and failure rate, despite the more extensive lesion size. Combined anteroinferior and superior labral lesion behaves more like isolated anteroinferior labral lesion than superior labral lesion.

The waterpolo shoulder paradigm: results of ultrasound surveillance at poolside

BackgroundWaterpolo consists of a combination of swimming and throwing with close contact between players. The shoulder is the most frequently injured joint, with a combination of rotator cuff tear and...

Development of the Human Biceps Brachii Tendon and Coracoglenoid Ligament (7th-12th Week of Development)

The goal of this study is to clarify the development of the long head of the biceps brachii tendon (LHBT) and to verify the existence and development of the coracoglenoid ligament. Histological preparations of 22 human embryos (7-8 weeks of development) and 43 human fetuses (9-12 weeks of development) were studied bilaterally using a conventional optical microscope. The articular interzone gives rise to the LHBT, glenoid labrum, and articular capsule. During the fetal period, it was observed that in 50 cases (58%), the LHBT originated from both the glenoid labrum and the scapula, while in 36 cases (42%), it originated only from the glenoid labrum. The coracoglenoid ligament, first described by Sappey in 1867, is a constant structure that originates at the base of the coracoid process and projects toward the glenoid labrum zone, which is related to the origin of the LHBT. The coracoglenoid ligament was more easily identifiable in the 36 cases in which the LHBT originated only from the glenoid labrum. We suggest that the coracoglenoid ligament is a constant anatomical structure, is not derived from the articular interzone unlike the LHBT, and contributes to the fixation of the glenoid labrum in the scapula in cases in which the LHBT originated only from the glenoid labrum. We postulate that, when the LHBT is fixed only at the glenoid labrum, alterations in the coracoglenoid ligament could lead to a less sufficient attachment of the glenoid labrum to the scapula which could predispose to a superior labral lesion.

Rupturas parciales del manguito del rotador: articulares, bursales e intrasustancia. Manejo en la población general en deportistas y trabajadores que realizan un gran esfuerzo físico. Técnicas de reparación

Partial rotator cuff tears do not have a clear understanding of its natural history, and for being a common pathology, committed to sedentary individuals, workers and athletes, but its conservative management and/or surgical treatment remains controversial. Partial ruptures are twice as frequent than total ruptures and may be associated with concomitant pathology as superior labral lesions, biceps pathology and cartilaginous injuries among others. Evidence levelIV.

Imaging the Glenoid Labrum and Labral Tears.

The shoulder joint is the most unstable articulation in the entire human body. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. There are many elements that work in combination to offset the inherent instability of the glenohumeral joint, but the glenoid labrum is perhaps related most often. Broadly, clinical unidirectional instability can be subdivided into anterior and posterior instability, which usually raise concern for anteroinferior and posteroinferior labral lesions, respectively. In the special case of superior labral damage, potential dislocation is blocked by structures that include the acromion; hence, while damage elsewhere commonly manifests as clinical instability, damage to the superior labrum is often described by the term microinstability. In this particular case, one of the radiologist's main concerns should be classic superior labral anteroposterior lesions. The glenoid labrum is also subject to a wide range of normal variants that can mimic labral tears. Knowledge of these variants is central to interpreting an imaging study of the labrum because misdiagnosis of labral variants as tears can lead to superfluous surgical procedures and decreased shoulder mobility. This article reviews labral anatomy and normal labral variants, describes their imaging features, and discusses how to discriminate normal variants from labral tears. Specific labral pathologic lesions are described per labral quadrant (anteroinferior, posteroinferior, and superior), and imaging features are described in detail. Online supplemental material is available for this article. ©RSNA, 2016.

Trends in Long Head Biceps Tenodesis

Background: Tenodesis of the long head of the biceps tendon has become a popular surgical treatment option for patients with pain or instability attributed to a diseased or unstable biceps tendon. No previous studies have characterized the practice patterns of surgeons performing biceps tenodesis in the United States. Purpose: To investigate current trends in both arthroscopic and open biceps tenodesis across time, sex, age, and region of the United States as well as associated charges. Study Design: Descriptive epidemiology study. Methods: Patients who underwent biceps tenodesis (Current Procedural Terminology [CPT] codes 23430 and 29828) for the years 2008 through 2011 were identified using the PearlDiver Patient Record Database, including both private-payer and Medicare data. These cohorts were then assessed for associated diagnoses using International Classification of Diseases, 9th Revision, codes and concomitant procedures using CPT codes. These searches yielded procedural volumes, sex and age distribution, regional volumes, and average per-patient charges. A χ2 linear-by-linear association analysis, Student t test, and linear regression were used for comparisons, with P < .05 considered significant. Results: A total of 44,932 biceps tenodesis procedures were identified from 2008-2011. The incidence of biceps tenodesis procedures per 100,000 database patients increased 1.7-fold over the study period, from 8178 in 2008 to 14,014 in 2011 (P < .0001). An increase in the overall percentage volume was noted in patients aged 60-69 years (P = .039) and 20-29 years (P = .016). The overall charges for arthroscopic tenodesis increased at a rate significantly greater than that of open tenodesis (P < .0001). Rotator cuff tear or sprain, bicipital tenosynovitis, biceps tendon rupture, superior labral lesion, and osteoarthritis were the most common diagnoses associated with biceps tenodesis procedures. A significant increase in isolated biceps tenodesis was also observed over the study period, from 1967 patients in 2008 to 3565 patients in 2011, representing a 1.8-fold increase. Conclusion: The incidence of biceps tenodesis has increased yearly from 2008-2011. Arthroscopic tenodesis has emerged as a more popular technique. Charges associated with the procedure have increased significantly. Significant regional variations in procedural incidences exist.

Effects of biceps tension and superior humeral head translation on the glenoid labrum.

We sought to understand the effects of superior humeral head translation and load of the long head of biceps on the pathomechanics of the superior glenoid labrum by predicting labral strain. Using micro-CT cadaver images, a finite element model of the glenohumeral joint was generated, consisting of humerus, glenoid bone, cartilages, labrum, and biceps tendon. A glenohumeral compression of 50 N and biceps tensions of 0, 22, 55, and 88 N were applied. The humeral head was superiorly translated from 0 to 5 mm in 1-mm increments. The highest labral strain occurred at the interface with the glenoid cartilage and bone beneath the origin of the biceps tendon. The maximum strain was lower than the reported failure strain. The humeral head motion had relatively greater effect than biceps tension on the increasing labral strain. This supports the mechanistic hypothesis that superior labral lesions result mainly from superior migration of the humeral head, but also from biceps tension

How often do surgeons intervene on shoulder labral lesions detected at MR examination? A retrospective review of MR examinations correlated with arthroscopy

We report the prevalence of surgical intervention on shoulder labral lesions detected at MR examinations and how surgeons describe labral tears seen at MR examinations in their arthroscopy reports. A retrospective review of 100 consecutive patients aged 50 years or younger who had shoulder labral tears on MR and went on to have surgery performed. It was determined whether surgical intervention was performed on the MR lesions. Of these 100 patients, 72 had superior labral anterior to posterior (SLAP) tears, 38 had posterior labral tears and 28 had anterior labral tears on MR examination. All 100 patients went on to arthroscopy. All lesions described on MRI were described on arthroscopy. Of the 72 SLAP tears, 64 were described as fraying on arthroscopy with 51 debrided. The remaining eight SLAP tears were tacked surgically. Of the 38 posterior labral tears, 36 were described as fraying on arthroscopy with 29 debrided and 2 had surgical tacking performed. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. There were four SLAP tears, two anterior labral tears and three posterior labral tears seen on arthroscopy but not seen on MR examination. In this series, a high percentage of SLAP tears and posterior labral tears described on MR examination did not have surgical tacking. Most anterior labral tears had surgical tacking. Based on the above, our surgeons request we describe superior and posterior labral lesions as fraying and/or tearing, unless we can see a displaced tear. Most anterior labral lesions are treated with surgical tacking. MRI allows for sensitive detection of labral tears. The tears often are not clinically significant.

Morphological Characteristics of the Repaired Labrum According to Glenoid Location and Its Clinical Relevance After Arthroscopic Bankart Repair

Background: There have been no studies on the postoperative morphological characteristics of the restored labrum at different glenoid locations and its clinical relevance after arthroscopic Bankart repair with suture anchors. Purpose: To analyze the morphological characteristics of the restored labrum at different locations of the glenoid and their relevance to clinical outcomes as well as affecting factors and to trace the inserted suture anchors after arthroscopic Bankart repair using computed tomography arthrography (CTA). Study Design: Case series; Level of evidence, 4. Methods: A total of 46 patients (mean age, 26.5 ± 6.8 years) who underwent arthroscopic Bankart repair with absorbable suture anchors were enrolled in this study. Patients underwent CTA preoperatively and 6 months postoperatively as well as functional outcome evaluation preoperatively and at the last follow-up (>24 months) with the Rowe score and visual analog scale for pain. Labral height and width were measured on conventional axial CTA images at the 3-, 4-, and 5-o’clock positions twice by 2 raters. The postoperative measurements were also compared with those of the healthy anterior labrum, acquired from the same CTA examination of 32 consecutive patients (mean age, 26.5 ± 8.5 years) with superior labral lesions in the same study period. The postoperative difference in the measurements and between clock positions, and the relationship between the measurements and the clinical factors and functional outcomes, were evaluated. In addition, the locations of all suture anchors were traced on each CTA image, and outcomes according to the locations of the most inferior suture anchors were assessed. Results: The interobserver and intraobserver reliabilities of measurements at each location were excellent (Pearson correlation coefficient = 0.773-0.988). Of the 46 patients, 2 (4.35%) had redislocations after surgery. Postoperative labral height and width were significantly increased at all locations (all P < .001) up to a level similar to the healthy anterior labrum, with significantly larger values at the inferior location compared with the superior location (all P < .05). Patients who had a greater frequency of dislocations before surgery showed a lower postoperative labral height at the 5-o’clock position (P = .012), and this correlated with postoperative instability and poor functional outcomes by the Rowe score (P = .036). In most patients (41/46; 89.1%), the tips of the lowest suture anchors perforated the far cortex, and these anchors were mostly located below the 5-o’clock position (32/41; 78.0%). However, perforation of the far cortex did not affect functional outcomes. Conclusion: Surgeons should be cautious of restoring labral height at the inferior glenoid location for successful arthroscopic Bankart repair. In addition, attention should be given to inserting the lowest suture anchor regardless of clinical significance.

Bilateral Suprascapular Nerve Entrapment by Ganglion Cyst Associated with Superior Labral Lesion

Suprascapular nerve compression is a rare cause of shoulder pain. We report the clinical features, radiological findings, arthroscopic management and outcome of three patients with suprascapular nerve compression caused by labral ganglion cyst associated with SLAP lesion. We performed simultaneous suture anchor SLAP repair and cyst decompression with a blunt probe. Upon a two-year follow-up, patients recovered full shoulder function without pain or limitations in activities of daily living.

The MR arthrographic anatomy of the biceps labral insertion and its morphological significance with labral tears in patients with shoulder instability

IntroductionMost of the fibres of the long head of biceps tendon attach on the superior labrum just posterior to the supraglenoid tubercle. AimOur hypothesis was that posteriorly attached biceps tendons predispose to posterior superior labral tears and SLAP lesions. Methods and materialsA prospective analysis of all MR shoulder arthrograms for shoulder instability referred from the shoulder specialist clinics, performed during a one year period were reviewed by two independent observers who were blinded to clinical history. The biceps attachment was classified into four groups according to the method described in an earlier cadaveric study into four groups; posterior-type 1, predominantly posterior-type 2, equal contributions to both anterior and posterior labrum-type 3 and predominantly anterior labral attachment-type 4. Data was analysed using Kappa statistics and Fischer's exact test. Results48 patients (33 males and 15 females) were included in this study with a mean age of 32 years. Majority, 22 patients (46%) had a type 1 attachment of the biceps on the superior labrum. There was moderate intra-observer and good interobserver agreement with a Kappa of 0.58 and 0.63 respectively. There was a significant association between a type 2 attachment and posterior tears (p≤0.04) and also between a type 2 attachment and SLAP tears (p≤0.04). ConclusionOur results suggest that variation in anatomy of biceps origin influences the type of labral tears that occur in patients with shoulder instability. The importance of these findings could influence selection of individuals in throwing sports like cricket and baseball.

Orthopedic disease and sports medicine in shoulder joint

Recent developments in biomechanics and technology have improved our understanding of the shoulder joints. While the shoulder joint is the one of the most mobile joints in the human body, its stability mostly relies on soft tissue structures such as the glenoid labrum and capsular ligament. Traumatic anterior instability is the most common instability related to sports injury. Younger individuals have a higher rate of recurrence after nonoperative treatment after the first-time episode of anterior instability. Arthroscopic repair of the Bankart lesion provides reliable outcomes in most of the anterior instability, while selected patients with significant bone loss may require bony augmentation procedures. Posterior instability has been underestimated. Sports injury is commonly associated with symptomatic posterior instability, and posterior labral lesions are commonly found. Arthroscopic reconstruction of the posteroinferior height and ligament balance is required. Superior labral lesions are a commonly diagnosed disease in the shoulder. Care must be taken to avoid unnecessary surgical procedures especially in nonathletic populations without significant traumatic episodes. Partial articular surface tears are common among sports related rotator cuff injuries. Symptomatic articular surface tears require arthroscopic treatment such as debridement or trans-tendon repair.

Glenoid labral tear associated paralabral ganglion cyst presenting as a neck mass: A case report

Ganglion cysts have been identified and described for centuries in a large variety of anatomical locations ranging from the thumb to the ankle. 2 McEvedy B.V. Simple ganglia. Br J Surg. 1962; 49: 585-594 Crossref Scopus (102) Google Scholar Regarding the shoulder, studies have identified a high occurrence of ganglia associated with labral tears. 4 Piatt B.E. Hawkins R.J. Fritz R.C. Ho C.P. Wolf E. Schickendantz M. Clinical evaluation and treatment of spinoglenoid notch ganglion cysts. J Shoulder Elbow Surg. 2002; 11: 600-604 Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar , 5 Schroder C.P. Skare O. Stiris M. Gjengedal E. Uppheim G. Brox J.I. Treatment of labral tears with associated spinoglenoid cysts without cyst decompression. J Bone Joint Surg Am. 2008; 90: 523-530 Crossref PubMed Scopus (62) Google Scholar In this case report, we describe a ganglion cyst of the shoulder associated with an anterior to posterior superior labral (SLAP) lesion that presented with a painless expanding mass in the anterior neck above the clavicle. We present the clinical, imaging, pathology, surgical findings, and outcome of treatment.

Clinical Utility of Traditional and New Tests in the Diagnosis of Biceps Tendon Injuries and Superior Labrum Anterior and Posterior Lesions in the Shoulder

Background Clinical tests are a key element in diagnosing shoulder lesions. Purpose This study examined the clinical utility of traditional and new examination tests, the upper cut for biceps injuries, and the modified dynamic labral shear for superior glenoid labral lesions. Study Design Cohort study (Diagnosis); Level of evidence, 2. Methods A total of 325 consecutive patients who were seen for shoulder pain underwent a standardized clinical testing battery. Six clinical tests that have been previously reported in the literature (Yergason's, Speed's, bear hug, belly press, O'Brien's, and anterior slide) and 2 new examination tests (upper cut and modified dynamic labral shear) were performed. Clinical examination findings were correlated with findings in those who came to surgery (101 patients). Sensitivity, specificity, accuracy, positive/ negative predictive value, and positive/negative likelihood ratio were calculated for each test. A binary logistic regression analysis was used to determine which tests produced the most significant findings. Results For biceps disease, the bear hug and upper cut were most sensitive (0.79 and 0.73, respectively), whereas the belly press and Speed's test were most specific (0.85 and 0.81, respectively). The upper cut was most accurate (0.77) and produced the highest positive likelihood ratio (3.38). For labral injury, the modified dynamic labral shear demonstrated sensitivity of 0.72, specificity of 0.98, accuracy of 0.84, and a positive likelihood ratio of 31.57. A binary logistic regression analysis revealed that the combination of the upper cut and Speed's tests were significantly better at detecting biceps lesions (P = .021, R2 = .400) than other tests, whereas labral lesions were best identified by combination of the modified dynamic labral shear and O'Brien's maneuvers (P = .045, R2 = .641). Conclusion The new tests are helpful additions to the clinical examination for shoulder injury. The modified dynamic labral shear test demonstrates high scores for clinical utility and exhibits a high likelihood ratio, indicating a significant probability of affecting the clinical decision, which should moderately or significantly improve the diagnostic conclusion and allow the clinician to be more efficient in making an accurate diagnosis.

Comparison of Indirect Isotropic MR Arthrography and Conventional MR Arthrography of Labral Lesions and Rotator Cuff Tears: A Prospective Study

The purpose of our study was to prospectively compare the diagnostic accuracy of 3D isotropic indirect MR arthrography with conventional sequences of indirect MR arthrography for the diagnosis of labral and rotator cuff lesions on a 3-T MR unit. Thirty-six consecutive patients who were scheduled for shoulder arthroscopic surgery at our institution underwent indirect MR arthrography. Both conventional sequences and an additional 3D isotropic sequence were obtained 1 day before arthroscopic surgery. Two musculoskeletal radiologists prospectively evaluated the images in consensus for the presence of superior and anterior labral lesions and subscapularis and supraspinatus-infraspinatus tendon tears using the conventional sequences and the 3D isotropic sequence. We analyzed the statistical difference between the sensitivities and specificities of both methods using arthroscopic findings as the reference standard. Surgical findings confirmed the presence of 23 superior labral lesions, eight anterior labral lesions, 21 subscapularis tears, and 24 supraspinatus-infraspinatus tears. The sensitivity and specificity of the conventional sequences were 74% and 54% for superior labral lesions, 88% and 96% for anterior labral lesions, 67% and 85% for subscapularis tendon tears, and 96% and 75% for supraspinatus-infraspinatus tendon tears. The sensitivity and specificity of the 3D isotropic sequence were 70% and 85% for superior labral lesions, 100% and 100% for anterior labral lesions, 67% and 85% for subscapularis tendon tears, and 96% and 67% for supraspinatus-infraspinatus tendon tears. No statistically significant difference was seen in sensitivities and specificities for both methods. Three-dimensional isotropic MR arthrography sequences with multiplanar reconstruction can provide a similar capability for the diagnosis of labral and rotator cuff lesions as conventional MR arthrography sequences but in a shorter imaging time.

Three-dimensional Isotropic Shoulder MR Arthrography: Comparison with Two-dimensional MR Arthrography for the Diagnosis of Labral Lesions at 3.0 T

To compare the diagnostic accuracy of three-dimensional (3D) isotropic magnetic resonance (MR) arthrography with two-dimensional (2D) MR arthrography for the diagnosis of labral lesions of the shoulder performed by using a 3.0-T imager. Institutional review board approval was given for this retrospective study and informed consent was waived. From March 2006 to January 2007, 100 patients underwent 3D isotropic and 2D MR shoulder arthrographic imaging by using a 3.0-T imager and subsequent arthroscopic surgery. The 3D isotropic sequences were performed by using fast gradient-echo imaging with fat suppression (voxel size, 0.6 x 0.6 x 0.6 mm; imaging time, 5 minutes 32 seconds) and were evaluated for the presence of superior, anterior, and posterior labral lesions by using 3D isotropic and 2D MR arthrography. The statistical differences between the sensitivity and specificity for both methods were analyzed by using the McNemar test, with arthroscopic findings regarded as reference standard. Surgical findings confirmed 53 superior labral anterior posterior (SLAP) lesions, 17 anterior labral lesions, and five posterior labral lesions. Respective sensitivity and specificity were 85% and 96% for SLAP lesions, 100% and 98% for anterior labral lesions, and 80% and 99% for posterior labral lesions by using 2D MR arthrography and 83% and 96% for SLAP lesions, 100% and 96% for anterior labral lesions, and 80% and 99% for posterior labral lesions by using 3D isotropic MR arthrography. There was no significant difference in sensitivities and specificities of both methods; however, the power of this study was limited and larger comparison is needed. Isotropic 3D shoulder MR arthrography combined with a multiplanar reconstruction technique can help in the diagnosis of shoulder labral lesions as does 2D MR arthrography, but with shorter imaging times.